10.50 MB | 26:20 Min
Leslie Ludka is a Certified Nurse-Midwife who graduated from the midwifery program at the Yale University School of Nursing. After a year of providing full scope midwifery care to native Hawaiian and rural community women on the island of Molokai, Leslie returned to Boston, where she spent nine years at Brigham and Women’s Hospital, the primary teaching facility for Harvard Medical School. Since leaving that position, Leslie has been self employed with LML Consulting, providing full-scope clinical midwifery both nationally and internationally.
Welcome to your Pea in the Podcast, I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy.
This week, it’s all about the second trimester.
We’ll talk about the discomfort…
“My thighs felt like I’d been doing just a whole lot of leg exercises, but I hadn’t actually done any.”
And sex, is it okay? Will you even want to do it?
“All the time!”
We’ll go over the prenatal testing you’ll be offered during this trimester; should you do any of that? And we’ll find out what is going on with your growing baby…
“Second trimester is really fun, baby is really forming.”
We’ll talk to a wonderful certified nurse midwife, a couple of second trimester mommies who are going through this ride with you, in this Pea in the Podcast.
Well, you’ve made it through the first trimester with its fatigue and its mood swings and its morning sickness and now you’re in what they call “the honeymoon period” of pregnancy. Certified Nurse-Midwife Leslie Ludka says there are many reasons for this nickname.
“Most people do feel a little bit better, they’ve sort of gotten past the morning sickness if they had that, they’re not urinating quite as much, not getting up quite as much at night, people can see that you’re pregnant, people love to see a pregnant woman and you just feel better. You can eat things that you normally would be able to eat, they’re not going to upset your stomach, you’re not really extremely heavy with baby yet, so you’re still just as agile as you normally would be. So that’s why many people refer to it as the honeymoon phase.”
Mom-to-be Stephanie, who’s at the very end of her second trimester in her 27th week of pregnancy, has had the textbook honeymoon trimester.
“I’ve always felt really great. I think my moods are pretty good. I’m just big enough to enjoy your belly and being pregnant, but not so miserable that it keeps you from doing other stuff.”
But this isn’t true for everyone. It certainly isn’t true for Mandy.
“I can say the honeymoon was over before it began this time around. I am still in very active all day long morning sickness and taking anti-nausea medicine to make sure that I don’t again get dehydrated to the point of needing to go to the emergency room because that’s just not fun.”
I know, you’re promised morning sickness will go away the moment you flip your calendar to the second trimester, but Mandy is 20 weeks pregnant and is still sick all of the time.
“Lots of nausea and definitely a lot of vomiting. There have been days where I’ve been lucky to keep down a meal and water, and so the fun has been kind of this game — which meal is going to stay down, I don’t know so lets make each one as packed with nutrients as it can be because if that’s the winner, you want it to be the good one and not the one time you decided you were going to eat a snickers bar.”
If you’re still sick now, you’ve probably talked to your doctor or midwife about it. Mandy is taking medication to help deal with it.
“During the day I can take one called Zofran and it has helped tremendously. I still will feel nauseous sometimes, but I can eat and keep my food down, I can do things like bend over to pick up a toy without throwing up, and it definitely has helped. The biggest downside is it is really expensive. My insurance company will cover 12 pills in 30 days. If you do the math, you know that I am doing some serious rationing to make it work. I wait until things are really bad, then I take it and I eat while it lasts.”
But for most moms-to-be, the second trimester can even be fun. You’ll probably start feeling your baby move at somewhere around 17 weeks. You’ll feel well enough to go places and do things, but you are not too big and uncomfortable to enjoy them. That’s not to say there won’t be discomforts. You are growing to accommodate your growing and kicking baby and with that comes some odd discomforts.
“My thighs felt like I had been doing just a whole lot of leg exercises, but I hadn’t actually done any. But I guess just the stretching and everything just kind of moving and giving way, I felt like I had been doing a lot of exercising but had done none.”
And you may suffer from what’s called round ligament pain. This is really no fun and can sometimes be a little scary. It can be a sharp pain that stabs you in the lower abdomen, and it can cause you to double over or it can be a dull ache that lasts a little longer. Both are normal as the ligaments around your uterus stretch and thicken. If you are getting short jabs of pain that generally hit you when you change position, that’s fine, but you want to contact your healthcare practitioner if your pain sticks around after you have rested. If you’re having severe pain or if you’re experiencing painful or painless contractions more than 4 times an hour, call your caregiver. Also, if you are having low back pain or an increase in pressure in your pelvic area, well, it may be time to check in with your doc then, too.
And if you ever experience any bleeding or fever or burning when you pee, call your doctor.
Midwife Leslie Ludka says you also might experience some very normal joint pain.
“Our body produces hormones that want to loosen everything up so that when it is time, our baby can pass through our body and our body can loosen up to let baby pass through. So hormones create that, and that often will cause joint paint for women. Joint pain, they’ll lie down in bed and they ‘re oh, so comfortable on their side and then their joint muscle in their arm or their joint muscle at their hip starts to ache, and so then they just roll over to the other side and get back to sleep and within an hour so, then that side starts to ache.”
Some moms-to-be experience particularly acute pain in their hips, it’s called Symphysis Pubis Dysfunction or SPD. I had this and it can be bad enough to make you cry. Seriously. Mandy has SPD now and had it with her first pregnancy, and she has several tricks to help keep that pain at bay.
“A lot of actually thinking about my movement. When I get into the car, I sit on the carseat and swing my legs in, unless it is my husband’s vehicle, which is actually harder for me to get into, and towards the end of this pregnancy, I will probably have my stool that I bring with me even when I get into his car. When I get in and out of bed, our bed is very high and I’m very short, so I have a stepstool that I use to take about a foot off of that step so that I’m not separating my legs more than I have to, because that’s the type of movement that hurts. I sleep with a pillow between my knees, and when I roll over I try to keep my legs together as I roll over. And when I was in labor with my daughter, some of the information I read suggested that the downside to the epidural during that birth could be that I could find myself pushing in a position that would make the SPD worse or — God help me — permanent. Well, the last thing I wanted to do was that. So while I didn’t do labor with no pain relief, I did do it without an epidural because I was more afraid of that being permanent than I was of the labor pain.”
If you have had SPD, believe me, you understand that fear. I found that I always had to keep weight evenly distributed on my hips when I was seated or any time really to keep the pain away. Mandy has also had success with a chiropractor.
For the milder discomforts of the second trimester, a warm bath or a pregnancy massage might be just the thing for you. In fact, I suggest a massage regardless — and often — and before you are too pregnant to enjoy it. I got one at about 37 weeks, and I fell asleep about just as soon as it started and was snoring until it was over.
How about heartburn? Lot’s of moms-to-be get it.
“So we eat and if we lie down or even bend over to put scraps in the dog’s dish or put things in the dishwasher, when that food starts to come up and it starts to burn, it is just not going to stop. It’s just horrible for many women. So what I recommend is that people stay away from spicy food, fried food, tomato-based food and that they drink plenty of water, that’s my mantra, and that they don’t lie down or bend over for at least an hour after they have eaten something and that usually helps with the heart burn. Another little trick that I have learned along the way is sugarless gum, for some reason. I recommend sugarless only because of the sugar causing cavities in the teeth, but chewing gum for some reason really helps a lot of women. And then Tums and Rolaids have been used quite frequently without any adverse affects as well.”
If none of this works for you, talk to your doctor. There are medications that are safe in pregnancy that can help you feel better. Burning your esophagus is not a good thing, pregnant or not.
Heartburn may contribute to another problem you’re facing. You’re having some trouble sleeping. Well, Stephanie is, anyway.
“I’ve had heartburn come on pretty strong, especially toward the end of the second trimester and then my bathroom trips have started making an appearance during the middle of the night. I used to never wake up to use the restroom, but I have to now.”
Mandy is having some difficulty sleeping as well.
“There are times when it’s tough, and actually that hasn’t so much been the function of my size or the hips, but the pregnancy insomnia that last time hit at about 8-9 months, hit earlier. I sometimes have nights where I’ll wake up and either because I’m feeling sick or I just can’t sleep, I’m awake for a while and have trouble getting back to sleep. But so far, size hasn’t been as much of an issue in that.”
Both Stephanie and Mandy use the same techniques to try to get some restful sleep — pillows, lots of them!
“My husband, you know, he’s over in Egypt on the other side of the bed, and then on my side there’s me and my pillows.”
You can use regular pillows or any of the assorted pregnancy pillows on the market, but pillows will be a saving grace as you get bigger heading toward the third trimester.
Speaking of size, this is the trimester when you will start showing. Here is Midwife Leslie Ludka…
“For a first baby, most women don’t show too early. Around 18 or 20 weeks is when people might actually dare to say to you ‘are you expecting a baby?” Whereas if it’s your second baby, most women will show much earlier, usually between 12 and 14 weeks your family and friends will know something is different and they will ask you about that.”
With my baby, I didn’t start telling people at work I was pregnant until I was 20 weeks along and finally my little bump needed explaining. This is the second pregnancy for Stephanie, and she started showing much earlier.
“Right at the end of the first trimester, I didn’t actually have to fully get into maternity clothes, probably until about halfway through the second trimester, but I have only gained 8 pounds.”
Speaking of weight gain, you’ll probably gain a lot of it during your second trimester; you may gain half the weight you gain during your entire pregnancy between your 20th and your 30th week. How much weight will you gain during pregnancy? Well, if you were a healthy weight before you got pregnant, you should gain between 25 to 37 pounds. If you were underweight shoot for a weight gain between 28 and 40 pounds, and if you were overweight before pregnancy, you should try to limit your weight gain to between 15 and 25 pounds.
So what should you be eating? Well, remember you’re not really eating for two. You should be eating a healthy, balanced diet of roughly 2500 calories a day that includes plenty of fiber. Midwife Leslie Ludka says you should keep taking those prenatal vitamins, too.
“And mainly those vitamins are to replenish the stores of the mother. So baby will take whatever baby needs from the mother. If baby needs calcium and there’s not enough calcium, baby will take calcium and if it needs to come out of the mother’s bones to get into the bloodstream to get to baby, then that is the way it will be. So mostly the vitamins are to replenish the stores for the mother.”
I took prenatal fish oil as well. That’s something you could consider.
Your caregiver will also be watching you for symptoms of anemia, like fatigue, and you will be tested for it throughout your pregnancy.
“If it’s found that you are anemic and it’s a mild or moderate anemia, then often times that can be remedied with dietary supplementation. For example, green leafy vegetables, meat, liver, there are many, many things that people can take to supplement their diet that will give them an increased amount of iron and then in addition to that, there are iron supplements themselves and they come in pill form or a liquid form. Some people that are pregnant find that the liquid form is easier to digest. Unfortunately, when we take iron oftentimes it will cause constipation, so we really want to be aware of that side effect and make sure that we’re eating things that will make us go.”
Fiber will help. The American Pregnancy Association suggests 25 to 30 grams of dietary fiber per day from fruits, vegetables, breakfast cereals, whole grain breads, prunes, bran. Also drink plenty of water. Exercise also helps with constipation, and all of you should be doing some kind of exercise throughout your pregnancy.
“As long as you’re not going for the burn or pushing yourself too much. Some things that I would set in as qualifiers would be things like downhill skiing, things where you could easily fall and harm yourself or harm the baby, those sorts of things, again common sense, you wouldn’t necessarily be downhill skiing when you’re in second or third trimester. ”
During the second trimester,you’ll get to know you’re healthcare practitioner a little better. You’ll generally go in about once a month. Stephanie says appointments for her are quick and painless.
“They are usually fairly short and the doctor that I see, the OB that I see, has a nurse practitioner that she works with. A lot of times I will just see the nurse practitioner if the doctor happens to be out delivering a baby or whatever, and she’ll usually feel for my uterus with her fingers, and she’ll usually pull out her tape and measure. We always listen to the heartbeat on the Doppler, we always do those sorts of things and if the doctor is available, she’ll come in and just check in.”
Mandy’s experience, though, is a little different.
“Well, I’m scheduled to see my doctor on a monthly basis at this point. But I have seen my doctor a little bit more often than that because I have had some contractions and some bleeding this time around. So he and I have seen each other a little bit more this time than we planned.”
One thing you’ll talk about several times this trimester, prenatal testing. The first test you may be offered between 15 and 20 weeks this trimester is a simple blood test called the quad screen. It measures several things, one of which is alpha-fetoprotein protein or AFP.
“It’s just a screening tool. It’s not definitive. It doesn’t say there’s anything wrong or if everything is okay with the baby. What it says is, if that chemical is really high or really low, we have sometimes found that there may be problems for those babies. So, if the chemical is really high, we wonder about spina bifida and if the chemical is really low, we wonder about Down syndrome. But if the chemical is high or low, it doesn’t mean there is anything wrong, again it would just say, let’s do a little bit further testing. It may be that we took the blood sample too early or too late or maybe it is a twin pregnancy. There are all sorts of things that can influence the results of that test, and the other thing is the last time I checked it was only about 75% accurate. So we do that test and the results, if they come back positive or negative, there is a 25% chance that those results could be incorrect.”
And because of those percentages and the high rate of what some people call “false positives”, some moms refuse it. I didn’t refuse it, I got it done.
Stephanie didn’t refuse it either.
“The first pregnancy, I was a little bit more nerve-wracking just thinking about the tests, and all the tests were going entail because I had heard that they get a lot of false positives. So the first pregnancy was, you know, maybe a little more of a nervous time. But this time, really not. I think I was just a little bit more educated on the actual test.”
Mandy did refuse the test.
“It’s the same decision that we made when I was pregnant with my daughter, and ultimately it came down to the answers that we received, if baby was not healthy or what people would deem as a typical healthy baby, it wouldn’t change what we would do.”
Meaning in her case, she and her husband would not decide to terminate, regardless of the result of the test. How does Midwife Leslie Ludka feel when moms-to-be refuse this or any other prenatal test?
“I respect their opinion because by the time they’ve made that decision, we’ve talked it over enough that they have all of the information that they need in order to make the decision that is correct for them. And so if they don’t want to have that test done, that’s perfectly fine.”
However, most women who do get this test done or any other prenatal test during pregnancy do not get it because they would terminate their pregnancy. They get them because they just want to know more about the baby who is kicking them. Some women think they could be better prepared to parent a possible special needs child if they know about it in advance.
Some medical conditions require extra support at delivery to keep a special needs baby healthy. But again, most women who get a concerning result from this, the quad screen test, will go on to have a healthy baby without special needs. It just flags moms who might want further testing.
One of those tests is the amniocentesis.
“Then that’s where they take a sample of the amniotic fluid, they go in, they look on the ultrasound and they watch as they insert a needle into the abdomen, into the sac that the baby is in and they take a small sample of the amniotic fluid and that is a very definitive test. It gives just tons of information.”
And the results of this test are certain; there are no false positives or false negatives. Amniocentesis does impose a very slight miscarriage risk. A recent study put the amniocentesis-related miscarriage rate by 24 weeks of pregnancy at 600ths of a percent or about 1 in 1600 pregnancies studied. This is a much smaller risk than previously thought.
One prenatal test that almost no one refuses is an in-depth ultrasound at around 20 weeks. Midwife Leslie Ludka says this prenatal test is very informative.
“We can see 5 fingers, 5 toes, the length of the legs, we can look at the chambers of the heart, the structure of the brain. We can’t tell intelligence or that sort of thing, but they can take a pretty good look at baby and say structurally this baby looks very good, and they can pick up pretty subtle things that would maybe cause a little bit of an alert where we would want to look a little closer at that baby.”
But the reason a lot of people get excited about this test is, if you want to know your baby’s gender, most of you will be able to find out.
“When I think about my, the ‘big ultrasound’ I like to call it, I just anticipate it, and up until the day going in, ‘we’re going to find out if it is a boy or a girl; it’s the big day, we’re going to find out!’ And then when I actually get there, my husband and I are there, and I’m on the table and we’re looking at, you know, the baby’s arms and feet, and you just get so caught up in it, when they finally announce to you the sex, you’re like, ‘oh yeah, the sex, I forgot we were going to do that today!’ So it’s just kind of neat, you know, I kind of look forward to knowing if it is going to be a boy or a girl for so long, but then you actually get in there. It’s just neat to see everything else and know that you’ve got a healthy baby, and then they kind of throw that in last. It’s like, ‘oh yeah, that’s just an added bonus, now we know what it’s going to be.”
And for Stephanie and her husband, it’s a girl!
As far as prenatal testing goes, if you want some of them, all of them, or none of them, as Ludka said, this decision is yours, and yours alone. No one can make it for you, and no one decision is right or wrong.
You’ll get some other tests during the second trimester. Tests for you.
“Between 26 and 28 weeks, a blood test will be done again, to make sure that we have the, that mother has not developed anemia during the pregnancy, that she has not developed gestational diabetes during the pregnancy, and just to double check on the maternal blood type and screen to make sure that everything is looking really good for 12 weeks later for delivery.”
If you test positive for any of these things, your doctor will help you sort it out. These issues are all manageable.
Now, let’s talk about sex, baby! Lots of moms-to-be are still enjoying that surge in hormones that makes them want it….
“All the time.”
Go Stephanie! She is 27 weeks along. Is she having any trouble doing it comfortably?
“Not really, not really. You know, we just have to change our position a little bit.”
Mandy also has a heightened interest in sex this time, even with her SPD (her hip problems). For her positioning is key as well.
“Positioning — top is the way to go, especially with the hip issue, so that works out okay. And with breastfeeding my daughter came more breast sensitivity, so I actually enjoy sex more now. Go figure, who’d have thought it? This time around, I feel more comfortable in my own skin. I think it helps that this time around my husband, you know, he’s seen a whole pregnancy before and the changes and the result of that pregnancy, and so he has felt more attached to this baby growing in my belly than he did even with my daughter while she was still in utero. So we’re closer, and I feel better about myself than I did the first time.”
A lot of men, though, are a little uncomfortable making love to their partners when they are pregnant.
“He did, especially toward the latter part of the pregnancy, I just don’t think he wanted to make anybody uncomfortable.”
‘Anybody’ being Stephanie or the baby. If your partner is worried, talk to him. Reassure him that, barring doctor-ordered pelvic rest or some other issue, sex during pregnancy is perfectly safe. You also can have your doctor or midwife reassure him if need be. After all, no honeymoon would be complete without a little love, right?
So, that’s the second trimester for you.
What has been going on with your baby all this time? Here is Midwife Leslie Ludka…
“Second trimester is really fun. Baby is really forming — fingernails, toenails. The eyelids are still closed at 20 weeks, but the baby can hiccup. By 24 weeks, the baby has eyebrows, eyelashes. They’re skinny and they are red, but they’re looking like, just exactly like they are going to look. And then as they get into 28 weeks, this baby weighs about 2 and a half pounds.”
By the end of the second trimester, your baby could survive — with assistance — if it was born. But, of course, we want that baby to bake for one more trimester. It is the most daunting trimester, the third trimester. The one where size and aches and pains and needing to pee and not being able to sleep and labor, of course, are all on the agenda. You can start preparing for labor now, too, if you wish…
“You can start reading about it, you can start planning and thinking about it. If you want to do hypnobirthing or something like that, then the person that you’re doing that, that you’re training for that with will help you to do that and may start earlier than at 32 weeks, but typically most things start at 32 weeks.”
Of course, she is referring to classes to help you prepare for the big day, which will be here more quickly than you think, to which Stephanie, who is at the very end of the second trimester, will attest.
“I cannot believe how fast it has gone by, and I’ve tried to really slow down and enjoy every last minute of it because I think that this could very well be my last pregnancy, but it’s just gone by way too fast.”
So savor every minute of this experience, mom. It’ll be over soon enough, but the memories of this special time alone with your baby will last a lifetime.
We hope you’ve enjoyed this Pea in the Podcast: The Second Trimester. Please visit our website PeaInThePodcast.com for more information about our experts, to find links and transcripts and to register to get tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie. Thanks for listening.
A Special Thanks To…
Stephanie in Oklahoma and Mandy in Colorado for sharing their second trimester journeys with us for this podcast.